CEO SUMMARY: Physicians in Florida and their state medical associations continue to battle UnitedHealth over its laboratory benefit management program that uses the lab test ordering system by BeaconLBS, a business unit of LabCorp. The latest round in this fight is language in a Florida Senate bill that would prohibit the use of a “clinical decision support system and a laboratory benefit management program in certain circumstances.” A hearing on this bill will take place tomorrow.

IF IT TAKES PLACE TOMORROW as scheduled, a committee of the Florida legislature will hear testimony about the clinical decision support systems and laboratory benefit management programs health plans use to dictate how physicians may order laboratory tests.

This hearing is taking place because Senate Bill 1084 contains language that would prevent health insurers in Florida from requiring physicians to use such systems each time they order a laboratory test for their patients.

It is believed that this language was inserted into the proposed legislation because many physicians in Florida are unhappy with the laboratory benefit management program instituted last year by UnitedHealthcare and administered by BeaconLBS, a company owned by Laboratory Corporation of America. This program requires physicians, when treating patients enrolled in commercial UnitedHealthcare HMOs, to obtain pre-notification or pre-authorization for approximately 80 tests. (See TDRs, July 21 and November 3, 2014, and February 17, 2015.)

Over the past 18 months, many physicians and their state medical associations expressed serious criticisms of UHC’s laboratory benefit management program and what they considered to be detrimental aspects in the design and operation of the BeaconLBS system they are required to use.

Florida Senate Bill 1084 includes language that would restrict the ability of health insurers to use systems designed to direct how physicians order laboratory tests in specific situations. The current language in the bill says, “…prohibiting a health maintenance organization from requiring that a healthcare provider use a clinical decision support system or a laboratory benefits management program in certain circumstances…”

It is expected that tomorrow’s hearing will involve testimony from health insurers, physicians, and other experts. SB 1084 has many elements, so there may not be lengthy testimony regarding the wording of the restriction on the use of clinical decision support systems and laboratory benefit management programs.

It is significant that this language is included in the bill. It is evidence that the physician community remains unhappy with the design and operation of UHC’s laboratory benefit management program and the requirement that they use the BeaconLBS system to obtain pre-notification or pre-authorization for as many as 80 lab tests.

Practice of Medicine

Additionally, over the past 18 months, physicians and their state medical associations have regularly asserted that, by requiring them to use this lab test ordering system, UHC is interfering with their practice of medicine. Thus, the issue of control over how physicians order lab tests is just part of a greater battle that has existed in recent decades between health insurers—looking to control costs and encourage more appropriate utilization of clinical services—and physicians, who want the freedom to exercise their professional judgment when caring for their patients.

For their part, health plans, including UnitedHealthcare, have arguments in favor of using decision support systems to promote the use of evidence-based care. At tomorrow’s hearings, it is possible that health insurers will cite statistics showing that the practice of medicine varies widely from one doctor to another and from one county to another. Health policy experts have been making this argument for years.

As of press time, UnitedHealth had declined to comment about SB 1084. Meanwhile, it is expected that news of this language in SB 1804 may encourage laboratories serving patients in Florida to submit comments to lawmakers as they continue to shape this bill.

FL Bill Would Restrict Some Use of Lab Order Systems

NOW PENDING IN THE FLORIDA SENATE, SB 1084: Health Care Protocols, would be called the “Right Medicine Right Time Act.” It would make changes to many aspects of how managed care plans, health insurers, and health maintenance organizations are allowed to conduct business. The bill also includes language that addresses the steps physicians need to follow when ordering prescription medications for patients.

The part of SB 1804 that deals with how physicians order lab tests says the following: “…prohibiting a health maintenance organization from requiring that a healthcare provider use a clinical decision support system or a laboratory benefits management program in certain circumstances…”

In explaining those circumstances, the bill says:

“A health maintenance organization may not require a healthcare provider, by contract with another healthcare provider, a patient, or another individual or entity, to use a clinical decision support system or a laboratory benefits management program before the provider may order clinical laboratory services or in an attempt to direct or limit the provider’s medical decisionmaking relating to the use of such services.

“This subsection may not be construed to prohibit any prior authorization requirements that the health maintenance organization may have regarding the provision of clinical laboratory services.”